| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,234 |
5,221 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
6,965 |
6,954 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,756 |
1,269 |
$111K |
| D0274 |
Bitewings - four radiographic images |
5,232 |
5,227 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,794 |
6,760 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
7,223 |
7,156 |
$67K |
| D9990 |
|
2,941 |
2,802 |
$64K |
| D1120 |
Prophylaxis - child |
1,989 |
1,982 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,471 |
3,463 |
$39K |
| D1351 |
Sealant - per tooth |
244 |
121 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
234 |
159 |
$12K |
| D9110 |
|
638 |
636 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
439 |
436 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
217 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$926.31 |